The Patient's "Guests"
As health care professionals, we have a unique opportunity to meet many people who affect us in so many ways. Our patients challenge and encourage us, and each one has a story. If we're lucky, we are allowed the rare opportunity to not only know our patient--we get to know our patients' loved ones, too. I love it when a loved one wants to help and become involved in my patient's care. There are some instances when those who try so hard to help inadvertently create unusual situations that can be, well, non therapeutic. I have some favorites I'd like to share with you.
Oh, yes, we know them. The throngs of visitors, family members, and guests who flock to comfort our patients. This is just for fun. See if you can name some of our favorite guests.
1. The good Samaritan who brings your post-surgical NPO except ice patient some pungent tacos because the patient said he felt hungry. Patient eats three bites and begins vomiting epically. The visitor, big-eyed and instantly remorseful, tells you, "But he said he was getting really hungry and you guys weren't bringing him anything!" At least three places in the room, including the door, say "NPO x Ice". There will be Phenergan. Visitor bolts because of the smell and leaves the wrappers in the garbage.
2. The PCA pump spouse who watches the clock and pushes the PCA button every ten minutes, even if her husband is asleep. She tells me she doesn't want him to wake up in pain. Luckily, with the help of Narcan and some skilled critical assistance folks, the husband gets to see his wife's face again. No matter how many times you educate...
3. To my young patient's friend: I can see you care about your buddy's comfort and worry that we aren't giving him his choice dose of powerful narcotics. There are reasons. He is constipated, he is experiencing AMS, and a zillion other things. While it's kind of you to bring supplementary meds and slip them to your friend, it kind of messes up his breathing and living. Please don't visit again.
4. I like meeting my patient's relatives, but if I have already met 20 and answered the same 400 questions, I'm going to nicely ask you to start talking to my patient or to each other. Maybe bring a tape recorder when the doctor comes in if the patient agrees. I want you all on the same page.
5. Speaking of relatives, I know the hospital can be noisy, cold, annoying, and frightening. Should your facility permit, I have no problem with one of your relatives staying overnight. Just a foreword--the couches don't get any more comfortable, we will be coming in the room to do annoying procedures like vital signs and medication administration, the room will either be too hot or too cold, the patient down the hall may yell, there may not be 4 pillows readily available, and the TV does not have HBO. Plan accordingly.
6. We love kids. We just don't love it with young children decide to bounce on Grandpa and bust his stitches. Unfortunately, the care providers prefer that catheter bags, oxygen devices, JP drains, bed controls, suction canisters, computers, IV pumps/poles, and just about any cool thing be left to the appropriate hospital care provider. We hate to be a bummer. Oh yes, and the gloves. The gloves won't hurt you, but if you pull the entire box on the floor, it costs the hospital money and we don't want that.
7. Dear overzealous advocate for your sick loved one: I am proud of you for standing up for your friend/family member who isn't feeling 100%. I am happy to report complaints to my supervisor and if I can rectify the problem, by golly, I will. I can not help the shows on TV, the food, the lack of closet space, the consistency of the sheets, the brand of orange juice the hospital provides, the absence of a beauty salon, cafeteria hours, erratic doctor's rounds timing, or the size of your room. I will give you some paper to write those things down for my supervisor or let you talk with my charge nurse. I know I will get bad patient ratings for not correcting all these problems. Next time I will learn.
8. Please, guys. Don't ask me about labs. I want to tell you. I can't tell you. I'm sorry.
9. Shift change is a bad time to call about an update on patient condition. Try to call 2 hours before or two hours after shift change. If before shift change, the last shift nurse can give you the low-down. If you call a few hours after shift change, I will have a good handle on your loved one's status. Otherwise, it might be messy and I won't get a chance to thoroughly evaluate my patient.
10. If you are a visitor and if you curse, threaten, hit, or disturb my patient in any way, you will be leaving. Same goes for me and my colleagues. This is a place for healing.
11. Family drama is not conducive to healing. If grievances must be aired, please have quiet, non disruptive discussions. Screaming profanities is not therapeutic and everyone will be asked to leave.
12. I like help, don't get me wrong. But, uh, no matter how strong you are, certain patients require certain strategies to move about, pivot to the commode, whatever. The patient might wind up caught up in any number of tubing, fall, reopen a wound, etc. I like your go-getter attitude, but I'd prefer to help you get the hang of things. I like my patients unharmed.
13. We all make mistakes. Usually they are minor. It is painful, not fatal, if I accidentally blow an IV on MawMaw's floss veins. Don't call me names, don't assume I am just poking around for kicks. I'll get help if my technique fails. Twice is a good number before I ask another colleague.
14. I do love family stories, and I'd love to hear them all, but a floor nurse is on the go 24/7. I'm not ignoring you.
15. Please let the patient talk if he/she can.
16. There's generally a reason I ask patients' families to call me should something happen. Please don't unhook an IV, remove a mask, or any other 500 things without assistance. Some things could turn out bad.
17. Do not sneak alcohol to my patient.
18. Please do not paint my patient's nails, dye her hair, or otherwise alter her appearance unless it's been run by the doctor or me. The polish irritates other patients' lungs and dying hair is messy. No make-up... it's a no-no for surgeries. Please don't clip toenails, wax, or beautify without first checking with your nurse. Some hair styling tools may burn patients and hospital beds.
19. For those randy, lonely spouses missing their lover in the hospital: NO. Your time will come.
20. Visitors, never assume you know what's in a random cup.
21. No strippers. I don't know why I have to include this.
22. But I must say, on the whole, a good friend or family member helps brighten my patient's day. Please watch to see if my patient looks tired or in pain, because he/she may need a break. Your love, support, and comfort help beyond what I can do sometimes.
Ya'll got some "guest" goodies?Last edit by Joe V on Jun 14, '18
About rnsheri, BSN
Joined: Sep '12; Posts: 54; Likes: 297
Specialty: 3 year(s) of experience in Med/Surg, orthopedics, urologyJun 18, '15The doting family member who waits on Mom hand and foot at home, and is astonished when you "make" her feed herself or get up to the chair unassisted. Same family member is later observed manhandling Mom back into bed while Mom hangs like a wet noodle. Not going to fix that level of dysfunction in a couple of days.Jun 18, '15Visitors who expect a true guest experience and request food and beverages, before I can assess my critically ill patient, as if they are placing their order in a restaurant.
The child who leaves the elderly parent with cognitive decline to spend the night in the recliner.
Visitors with rolling suitcases. Please take that out to your car.
Do not call me to give the patient a sip of water
because you are too busy talking to multiple guys on a dating site.
Do not tell me to give the patient with altered mental status something just so you can go back to sleep.
CD players played at full volume. That is not conducive to rest and healing.
Do not expect us to allow you to have a notary witness the patient sign his assets over to you at ten o'clock at night. We expect legal matters to be transacted during normal business hours with your case manager.
Excellent post. Should be on the article page.Last edit by icuRNmaggie on Jun 18, '15Jun 18, '15If we are preparing to do an invasive procedure, it is not the time to stand in the doorway of another patient's room and say, with a smirk on your face, "I'll take my morning coffee." We are not going to hold off on saving this man's life so that you can have coffee.Last edit by icuRNmaggie on Jun 18, '15Jun 18, '15I have a few more goodies. I love my job so much! I mean, who else gets to experience these joys?
21. To the family bickering at a terminal patient's bedside: STOP. In most cases, you guys have had time to plan for this. I don't want to hear about how it's not fair that Susie gets the house but Barbie only gets certain heirlooms that she doesn't even want. Even if the patient is comatose, let's just pretend that my patient can hear. If you can't dig that, I can hear. It's stuff. I'm a caretaker, and I don't care who "deserves" this or that. Just be there. If you don't have the decency to support that poor man in his last hours, I will find some way to get you guys out of the room. I may not be able to tell you to leave up front, but I can devise many procedures that involve unpleasant smells or awkward positioning and I will tell you that I'm going to do those and need privacy. I know, lying is bad, but the guy deserves one person to say something nice to him, and, for maybe just a minute, that'll be me.
22. Please don't think name-dropping will get you VIP treatment. There's no such thing.
23. I think I have a hovering little old lady somewhere every shift. I just adore her. Usually she's sicker than her husband, who just had a prostatectomy or some such done. She's fixing his sheets so they are perfectly straight, organizing his bedside table, making sure he has his favorite clothes to go home with when he leaves, pours his drinks, feeds him herself, worries over the catheter bag when it's 1/10 full, makes sure I remember (for the 100th time) that he likes grape juice and not cranberry juice, has her own quilt over him, and is constantly fielding phone calls from an endless number of relatives, friends, and preachers. It's cute, but sometimes my little patient isn't in the mood. He doesn't want to talk to 70 different people, he's happy to cut up his own food, and he wants some space. This means the well-meaning, doting wife gets worried. "He doesn't usually act like this, is he OK? I mean, there's nothing wrong right?" In my mind: I doubt it. He's hurting, he's stressed, and he's had a surgery. Maybe some space? Let him do some things for himself? He might be afraid his independence is being lost.
24. I have no problem with a patient's family member bringing in a computer, Ipad, cell phone, whatever. I just can't see how the patient is helped when you never even get off the phone to glance over and see your loved one. I guarantee you, your Internet connection is better. I can't do anything about it. It's nice to see you here, but why aren't you engaging with your loved one who is frightened and uncomfortable? And some of the cell phone conversations are more fit for a ship full of sailors.
25. It is not nice to wheel your loved one out of the room to explore the hospital without telling me. Even worse, this excursion usually has a bad ending. NPO patient needs a snack from the cafeteria, neutropenic patient takes a leisurely stroll outside in the middle of pollen season ("But he just wanted to see the flowers!"), or, even better, the wandering family unit gets lost and winds up... well, anywhere they wind up can be bad. You have a good heart, family member, but again, there are reasons to run things by us.
26. Dear families and friends, help me out and take your loved ones valuables home if, say, a surgery is scheduled the next day. We do not recognize "lucky" necklaces, nail polishes, rings, earrings, etc. I understand that wearing a rosary may bring a patient peace, but we remove jewelry, fake hair, make-up, nail polish, etc. for specific practical reasons. I'm not being insensitive, I'm trying to make sure that your loved one has the safest procedure possible. I also feel better with valuable items in safe hands.
27. Don't burn candles, cigars, incense, or anything in the hospital. At all. I respect your religious beliefs. I understand that it feels like we're oppressing poor Uncle Sal by denying him his smokes. It's this simple: I don't like getting blown up. I will be glad to tell you about the dangers of oxygen and combustion. Many religious ceremonies can be done safely with fake candles, etc.
28. I am so, so sorry to inform you of this, dear visitors (and patients). On a med/surg floor, things beep. That goes triple for critical care units. The pumps beep for a variety of reasons, letting us know we need to fix something. SCD's beep when they aren't on correctly, blood pressure monitors beep, continuous pulse-ox monitors beep, telemetry monitors beep, and sometimes even the beds beep. We are keenly aware of this and can usually differentiate each beep. Not every beep means something terrible. And, trust me, I know the it's annoying when your IV won't quit beeping. So please, work with me. If the IV is in your AC and you move your arm a lot, there's a good chance I will offer to move that IV if I feel I can. Patients and guest get mad at "that stupid machine" no matter how many times I explain the mechanism behind the alarm triggering. Many times in ER the fastest access site is the AC, but for "floor" patients, movement and discomfort present a problem. I want to help you, so let me.
28. I really want you to stay if your loved one "has dementia, will travel". Bed alarms, frequent checks, etc. etc. are not sufficient. No matter what we do, we're still going to have other patients and can't watch your loved one all the time. I am genuinely sorry for this. I often suggest families taking shifts if possible. IV's and catheters get ripped out, patients fall, and some self harm. Quite a few are not fans of us, at all. I don't expect you to magically calm the patient or restrain him/her. I just need another set of eyes. To you, dear family, I wish you didn't have to do this. It's painful, the person can be mean and violent, and I know sleep is more of a pipe dream than a reality. I wish I could provide you with 1:1 staffing. All I can do is take just one extra step to keep your loved one safe.
30. I like that you want to celebrate Emmajean's birthday, but be reasonable. I am having to sift through a sea of balloons, flowers, candy (not allowed, by the way), and 20 relatives to change a dressing. I like cards. Cards don't trip patients. Rotate guests. Be mindful that, birthday or not, enemas may need to be given, catheter bags need changing, needles may be needed, infected wounds may smell, and I may need to undress Emmajean to evaluate her. I need quiet to hear heart and lung sounds. And half the time, all of you will hate me because I say no to the candy if it's not permitted, no to kazoos and boisterous renditions of happy birthday 6 times an hour, no to cake candles, no to flowers if on special precautions, no to trips to the zoo, etc. and so on.
31. With very few exceptions, dogs, cats, lizards, parakeets, etc. are not allowed in the hospital.
I know I sound like a meanie sometimes, but I get no enjoyment out of saying "No". Well, most of the time I hate to say no. My patients look forward to visits, and they light up when they get company. Pain seems to decrease. I like to hear my sick patients laugh. I like that they feel wanted. I have a duty to protect my patients, however. I don't care if I get a bad HCAPS score if my patient stays safe because I didn't allow them to eat cake when she is NPO for suspected ileus. I plan on compiling a list for patients, too, whenever it seems relevant. I like humor .Jun 19, '15Two days ago I answered a call light, family member said a fresh c-section pt needed pain meds. Ok, cool. I go down to investigate since the primary RN was crazy busy. While I'm asking the pt about pain a family member says, "Just so you know that pump was beepin' and nobody came to check on it so I just turned it off. It said low battery." I thought oh she means she she silenced it. Nope, she turned the pump OFF. Straight up. The post-delivery pitocin! I start frantically trying to get it restarted while educating about the importance of letting us know if the pump is alarming while simultaneously locking the pump, all the while imagining a hemorrhage under the sheets. Family member gets in my face and says, "quit worrying about that dumb pump, do your job and get me a Sprite and a warm blanket." Who is the patient again? I had a Bonquiqui moment after that... Sa-curity!Jun 19, '15When the patient had surgery 3 hours ago, she is not in a party mood. I'm sure she is glad to see all 15 of you, but please don't all hang around for hours, yukking it up and then ask me why she is having so much pain and nausea. And thank you for "getting it" and leaving promptly and politely when I explain about people needing rest and space after surgery.
Do not let me catch you lying on the bed while waiting for your loved one to arrive from PACU. That is one sight that causes me to think homicidal thoughts.Jun 20, '1512 year old comes out of his mothers post partum room carrying his 2 hour old brother and tells us that "my parents are tryin' to sleep and he won't stop making noise". ermmm.....yeahJun 20, '15I had my own horrible version of #23 once, except it was the severely disabled patient's mother instead of his wife. How much she doted on him was almost cute - the way she'd get on us if mouth care wasn't done precisely every two hours on the dot (thanks, whichever jerk went over the mouth care policy in detail with her), the way she'd ask so sincerely when the last time we turned him was...
You could almost forget the reason he was in the hospital in the first place was because every single bony prominence on the side that this nonverbal patient "said" he preferred to lay on had pressure ulcers to the bone, and he was covered in urine and stool on arrival. He apparently "liked" to sleep on the floor, just the same way he adored watching Dancing with the Stars when he wasn't watching Nick Jr. Sick, sick woman. That's one of only two times I have requested a different assignment - I literally could not walk in that room one more time without snapping.
Gotta love the overzealous visitors trying to make up for the heaps of abuse they've piled on the patient at home.Jun 21, '151. I understand that people generally do better with visitors but when there is a large groups of 20-30 visitors for one patient and they camp out in the waiting rooms, picnicking and eating and not cleaning up after themselves it really bugs me. These large groups tend to make an entire outing of the event and spend all day in the hospital.
2. Again when the room is packed with a lot of visitors and I enter to take care of the patient I often notice that the visitors make no effort to to get out of the way so I can complete the task(s). I often have to politely to tell them I need to get to the patient so I can take care of them. I would think that this is obvious as that is why their loved one is in the hospital but it happens so often I have given up expecting it.
3. This is common courtesy but I except people to pay more attention to it in a hospital. Please let hospital staff with their equipment and patients in wheelchairs and on gurneys get OFF the elevators before you all try to pile in.
4. Children playing on the floor drives me crazy and children that are not supervised well and are allowed to run around. scream and misbehave. Please take your small children home and do not camp out for 12 hours with screaming, tired and crying children unless your loved one is dying. I have seen this so many times and have come to learn the patient had some minor procedure. I do not understand these marathon visiting hours!Jun 21, '151. Mathematically Challenged Family. The notice over the phone that you called to get access into the ICU says "Two Visitors at a time" for a reason. Do you REALLY a think I won't notice TEN of you at the patients bedside? I can't see the vent, nor the patient because I can only see You all.
2. Bondage Averse Family.
Yes, I really DO need you to STOP taking Dad's wrist restraints off because this is the Second time that he's needed to be re-intubated because he pulled his ETT out, and don't even get me started on how many OG's I've had to reinsert because of you.....
3. Sedation Vacation Family.
Please, for the love of God ~ stop trying to get my patient to wake up. As I've explained numerous times, I am trying to Sedate you loved one. The fact that you are shaking him and yelling in his ear is only going to hasten kidney failure from the ever-increasing doses of sedation that I'm having to give him because of you.Jun 21, '15NPO x Ice means nothing to most visitors/family members. How about Don't feed the patient, only give ice chips.Jun 21, '151. (When I worked at a nursing home as a CNA) The family who puts their loved one in a nursing home but harps on the staff to make sure their loved one is taken care of to their standards, the dentures are always in a particular place, the sheets are perfect, the room is always immaculate, and won't hesitate to make your life hell and report you. Watches every thing you do with daggers in their eyes, looking for the slightest "wrong." It's always fun delivering care to your loved one, when she hits, kicks, and tries to bite our fingers off. We give her the best care we possibly can, but remember we also have 14 other patients to take care of. We don't have the time to deliver 1:1 care to your loved one.
2. The family member who claims to be in the medical field and yells at you in the doorway of her loved one's ER room because of her needing to go to the ICU because her labs aren't good and her vitals aren't the best.
3. Pt is in isolation with C-diff. Whole herd of family comes in, refuses to wear isolation gear even after teaching the importance of it.
4. Unresponsive elderly pt arrives in ER with advance directives not to do anything. One brother is POA, the other isn't, and are yelling and arguing about the advance directives. The POA is on board with his father's wishes, the other one (who's been estranged), of course, isn't. Demands you follow their instructions and not the other brother's.
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